Multiaxial classification in child and adolescent mental health – a reaffirmation of benefit and practical applications

Abstract

Objective: Classification systems and their practical implications have become increasingly important in child and adolescent psychiatry. This paper presents the evolution and practical applications of a multiaxial classification system for children and adolescents presenting to mental health services. Included are some worked examples demonstrating both the complexity of many presentations and how broadening the use of the multiaxial system can help in identifying appropriate interventions. Conclusions: Classification systems in child and adolescent psychiatry have largely remained uniaxial in nature. A multiaxial system encapsulates the broader biopsychosocial aspects of the presenting child or adolescent, and orders complex data in a concise manner. This approach can be used to concisely communicate with other treating clinicians, and assist with case reviews, formulation and teaching.

Practical aspects of multiaxial classification: a clinically useful biopsychosocial framework for child and adolescent psychiatry

“…That is because the use of such a system allows the capture of multiple factors beyond just a symptom cluster and categorical diagnosis. It allows a far richer understanding of the clinical presentation (Mayall 2021) while hopefully suggesting interventions (as discussed below) that are not just targeted at a single categorical diagnosis.…”

Child and adolescent mental health multiaxial classification: A useful biopsychosocial framework for paediatrics?

“…17 More recently additional ways have been suggested for the use of the multiaxial approach, which might support its clinical usefulness, including help with planning clinical intervention, case review, and supporting diagnosis and formulation. 18 In this article, a number of practical examples are put forward for its use as a tool by paediatricians. Given the overlap of conditions seen by both child and adolescent psychiatrists and paediatricians (especially developmental-behavioural paediatricians) and the need for close working relationships, a similar communication framework might prove advantageous.…”

“…Axis Six (Global Assessment of Psychosocial Disability) does not use codes from ICD‐10; instead, it has been suggested ‘as a first step towards the development of a systematic scheme for assessing social disability’ 17 . More recently additional ways have been suggested for the use of the multiaxial approach, which might support its clinical usefulness, including help with planning clinical intervention, case review, and supporting diagnosis and formulation 18 …”